Making Early Detection Possible: Medicare and National Cancer Screening Programs

There are four organised national screening programs in Australia today for breast, bowel, cervical and lung cancers. These have been enabled by Medicare, which pays for key services delivered by health practitioners and pathologists. This article focuses on the critical role of Medicare in the development of the National Cervical Screening Program, the first nationalised screening program of its kind. We examine the seven years between Medicare’s introduction in 1984 and the launch of the program in 1991, during which cost overruns led to government evaluations, policy refinement and advocacy for a solution that could be found in tying Medicare rebates to a standardised national public health scheme that made cervical screening available to all eligible Australians. We place this period in the longer history of cervical screening and explore how the lessons from developing the cervical screening program shaped the other three Australian cancer screening programs. The challenge of health equity remains due to the legacies of colonialism, discrimination and economic deprivation. Priority populations such as culturally and linguistically diverse (CALD), LGBTQIA + and First Nations communities continue to suffer poorer health, which is compounded by greater difficulty accessing screening. We conclude by discussing potential pathways to address these inequities.